Treating Irritable Bowel Syndrome
Updated on 7/28/09
IBS accounts for nearly 3.5 million physician visits in the U.S. annually and is the most common diagnosis in gastroenterologists' practice—despite the fact that only about 10 percent of people with symptoms bother to see a doctor. Several studies have suggested that the impact of IBS on quality of life is equally as significant as that of congestive heart failure and dialysis-dependent kidney failure.
But treatments exist that ease the symptoms of IBS. This section has more information on:
Medications
Many over-the-counter medications can help relieve symptoms of IBS. These include:
- Fiber supplements or mild laxatives such as Milk of Magnesia to relieve constipation
- Anti-motility medications such as loperamide (Imodium) or Kaopectate to reduce diarrhea
But be sure to follow your doctor's advice when using over-the-counter medications because laxatives can be habit forming if used too often, and antidiarrhea medications can cause constipation.
In addition, the following prescription medications are often used to treat IBS.
- Smooth muscle relaxants, including hyoscyamine (Levsin) and dicyclomine (Bentyl), may help relieve cramping.
- Tricyclic antidepressants such as amitriptyline (Elavil) imipramine (Tofranil) have been shown to relieve symptoms for people with severe pain and diarrhea. Lower doses are used than those typically given to treat depression.
- SSRI antidepressants (including Prozac, Zoloft, and Effexor) may help relieve symptoms in some people, although there have been few randomized clinical trials done to gauge their effectiveness.
One medication was developed specifically to treat IBS:
- Alosetron hydrochloride (Lotronex), which has been approved by the Food and Drug Administration for women with severe IBS who have not responded to conventional therapy and who have mostly diarrhea. This drug can have severe side effects, including constipation and decreased blood flow to the colon. Some deaths have been reported. Accordingly, patients must thoroughly discuss the benefits and risks with their physician before taking this medication. In fact, patients are required by the FDA to sign a Patient-Physician Agreement before they can receive a prescription for this medication.
Stress relief
Stress causes intestinal spasms in people with IBS, so reducing stress is a key part of treating the condition.
Nerves in the colon control the intestine's contractions. Many nerves connect the colon to the brain, which helps explains why people get "butterflies" in their stomach when they're nervous or excited. In people with IBS, the colon can respond to even the slightest stressor. Beyond that, stress tends to make people especially aware of uncomfortable or painful symptoms.
Research has found that a history of stressful life events or current distress often precedes development of IBS. Other studies have found that people developed psychiatric disorders prior to, or at the same time as, IBS symptoms. The most common psychiatric disorders among IBS patients are depresion and anxiety. These disorders typically respond well to treatment, and if left untreated can make IBS symptoms worse. Treatment options include psychotherapy or counseling and medications, such as antidepressants.
One form of psychotherapy, cognitive behavioral therapy, has shown promise for patients with moderate to severe IBS and for those with IBS and anxiety or mood disorders. CBT can help patients learn coping strategies to control the symptoms brought on by anxiety. Patients work with a therapist to modify their thinking about stressful situations and their perceptions about their gastrointestinal symptoms. As patients' cognitive appraisal of their reality changes, their bowel symptoms often improve.
Other stress management options include:
- Relaxation training, such as meditation, guided imagery, or biofeedback
- Regular exercise, including walking or yoga
- Breathing techniques
- Getting enough sleep on a regular schedule
A diary may help you recognize stressors that activate symptoms. The diary should include the symptom experienced and its severity; associated factors such as diet, activity, or stress; emotional response (feelings of anger, sadness, helplessness); and thoughts associated with the incident. A record of stressors and associated responses may help you figure out positive ways to better deal with the stressors.
Diet
Eating causes rhythmic contractions of the colon. Normally, this may cause a person to have a bowel movement 30 to 60 minutes after a meal. In a person with IBS, the urge to defecate may come sooner and may be accompanied by pain, cramps, and diarrhea.
Many people say their IBS symptoms are triggered by eating certain foods. As a result, treatment includes figuring out which foods are the culprits and avoiding them when you eat. Changes in diet reduce IBS symptoms in 50 to 70 percent of people.
Foods that commonly trigger IBS symptoms include:
- Dairy products
- Caffeine
- Fatty foods
- Vegetables, like beans or broccoli, that cause gas
- Foods containing the sweeteners sorbitol and fructose
- Wheat cereals
- Alcohol
Before changing your diet, take note over the course of several days which foods seem to cause problems. You may want to consult a dietitian to help you adhere to healthful eating strategies, such as:
- Drinking six to eight glasses of water a day, especially if you have diarrhea. Drinking carbonated beverages can increase discomfort from gas.
- Eating more fiber. Dietary fiber often helps reduce IBS symptoms in both patients who have constipation as well as those who have diarrhea. Whole-grain breads and cereals, fruits, and vegetables are good fiber sources. Starting a high-fiber diet may cause gas and bloating for a few weeks. Fiber supplements such as bran, psyllium derivatives, or polycarbophil (20 to 30 grams/day) may help relieve constipation and may also reduce diarrhea.
- Eating smaller meals more often or eating smaller portions. Large meals can cause cramping and diarrhea.
- Consuming probiotics, such as yogurt or acidophilus supplements. Some patients find they help reduce symptoms. Research suggests that adding "good" bacteria may help return the balance of the microflora in the bowel to normal or prevent disease-causing bacteria from attaching to the bowel wall.
Alternative therapies
Some people with irritable bowel syndrome have found help through alternative therapies:
Herbs, including chamomile, ginger, and mint, have been found to be helpful in alleviating gastrointestinal pain. One particular Chinese remedy, Changjitai, reduced diarrhea symptoms in a small clinical trial with 45 patients. Some herbs can interact negatively with prescribed or over-the-counter medications, however. It's important to consult your doctor before taking any herbal remedies so he or she can warn you of possible risks.
Pro-flora dietary supplements such as acidophilus and lactobacillus, taken two to three times per day, may rebalance normal bowel bacteria and reduce gas and bloating.
Regular exercise, such as walking, can reduce stress and encourage bowel movements. Therapeutic massage also may help in reducing the effects of stress. Hypnotism is another alternative therapy gaining attention for the treatment of IBS. Hypnotism may help IBS patients manage stress and anxiety and enhance coping skills. Several randomized controlled trials have shown that hypnosis brings about improvement in bowel function, reduces pain and abdominal distention, and increases well-being. While this type of therapy is more expensive than traditional medications, relief may be longer lasting.
No well-designed studies have evaluated the effect of chiropractic treatments on individuals with IBS, but it is thought that spinal manipulation may improve symptoms in some people. In these cases, spinal manipulation may have a positive effect on the nerves connected to the intestinal tract.
Some patients report symptom improvement from meditation and biofeedback therapies. Still others have achieved a degree of success and relief from symptoms with relaxation therapy.
Several small studies suggest acupuncture provides significant relief from chronic pain. In IBS patients, there are reports that acupuncture can relax muscle spasms and improve bowel function.
advertisement
